NH Claims Adjuster flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Indemnity principle

Coverage restores the insured to the same financial position held before the loss, not to a better one. This principle explains why depreciation and policy limits reduce payouts.

Insurable interest

A financial stake in the property or person insured such that loss causes economic harm. Required at policy inception for life insurance and at time of loss for property.

Actual cash value

Replacement cost minus depreciation. Used to value property at the time of loss when the policy does not provide replacement cost coverage.

Replacement cost

The amount needed to repair or replace damaged property with new property of like kind and quality, without deducting depreciation.

Coinsurance formula

Payout equals carried limit divided by required limit, multiplied by the loss, capped at the policy limit. Underinsurance reduces recovery proportionally.

Proximate cause

The initiating cause that sets a loss in motion without a break in the chain of events. It determines whether a peril is covered.

Subrogation

The insurer's right, after paying a claim, to pursue the negligent third party responsible for the loss in the insured's place. Prevents double recovery.

Reservation of rights

A letter stating the insurer is still investigating and may later deny or limit coverage. It cites the specific policy provisions in question and is not a denial.

Proof of loss

A sworn statement from the insured detailing the amount, cause, and date of loss. Policies commonly require it within 60 days of the insurer's request.

Comparative negligence rule

In New Hampshire, a claimant more than 50 percent at fault recovers nothing. At 50 percent or less, recovery is reduced by the claimant's share.

Bad faith exposure

Liability for unreasonable delay or denial without reasonable basis in first-party claims, or failure to settle within limits when liability is clear in third-party claims.

Net loss calculation

Gross loss minus deductible minus salvage recovery minus subrogation recovery. Adjusters track these offsets so the file reflects actual insurer outlay.

Total loss valuation

Settlement based on the vehicle's actual cash value using comparable market data. Prior damage and betterment adjustments must be itemized on the estimate.

Recorded statement consent

Statements must be taken without coercion. The adjuster obtains consent before recording and separates factual questions from opinions about fault.

HO-3 coverage structure

Dwelling covered on an open-peril basis; personal property on a named-peril basis. Coverage A dwelling, B other structures, C personal property, D loss of use.

Coverage C limit

Personal property under an HO-3 is typically limited to 50 percent of the Coverage A dwelling limit unless increased by endorsement.

HO-3 standard exclusions

Earth movement, flood, ordinance or law, intentional loss, neglect, and wear and tear. Flood requires a separate policy or endorsement.

Personal auto policy parts

Part A liability, Part B medical payments, Part C uninsured and underinsured motorists, Part D physical damage covering collision and other than collision.

CGL Coverage A

Commercial general liability coverage for bodily injury and property damage caused by an occurrence. Coverage B covers personal and advertising injury.

Business income coverage

Pays net income plus continuing normal operating expenses during the period of restoration. Many forms begin after a 72-hour waiting period.

Umbrella liability

Coverage above underlying auto, general liability, and employers liability limits. May drop down when underlying coverage is exhausted.

80 percent dwelling condition

Replacement cost settlement on a dwelling requires carrying at least 80 percent of the dwelling replacement cost. Below that, settlement is reduced.

Workers compensation

Statutory no-fault coverage providing medical benefits and lost wages for work-related injury. Employers liability covers suits outside the statutory scheme.

NH Insurance Department

State regulator under RSA 400-A with authority over insurer solvency, rate filings, market conduct, and producer licensing under RSA 402.

NH producer continuing education

Renewal typically requires 24 credit hours every two years, including ethics, plus compliance with prelicensing education and background check requirements.

NH rate standard

New Hampshire is a competitive rating state. Rates must not be excessive, inadequate, or unfairly discriminatory, and file-and-use applies to many lines.

Unfair claim practices

Under RSA 417, prohibited conduct includes misrepresenting policy provisions, failing to act promptly on communications, and refusing to pay without reasonable investigation.

NH cancellation notice

Insurers must give written notice of cancellation stating the reason. Nonpayment cancellations generally require at least 45 days' notice; other reasons 30 days.

NH guaranty association

Under RSA 404-B, member insurers fund payment of covered claims of insolvent insurers up to statutory limits, protecting policyholders and claimants.

NH insurance fraud

Insurance fraud is a crime under RSA 638. Adjusters report suspected fraudulent claims to the insurer's special investigation unit for referral.

Producer rebating prohibition

Producers may not offer inducements not stated in the policy, such as rebates of commission, and must disclose commissions on request under department rules.

Nonrenewal requirements

Nonrenewal must state the specific reason and follow policy notice terms. Insureds may seek review by the insurance commissioner.